Use the Household Income section to indicate:
- Your income level was below 100% of the federal poverty level
- Your tax family size - if different from the Federal return
- Dependent Household Income
Premium Assistance Subsidy Claim and Reconciliation of Advance Payment of Premium Assistance Subsidy (Part 2)
Within this section, you will enter the amounts reported to you on form 3895. If your form contains coverage from January to December with no change in coverage, select Yes and enter the column amounts as specified.
If your form does not contain coverage for January to December or has changes in coverage amounts, select No. You will need to use form 3895 to enter the amounts for each month individually.
Allocation of Policy Amounts (Part 4)
Select "Yes" to allocate enrollment premiums, SLCSP premiums, and/or APAS on Form 3895 between this taxpayer's applicable household and another applicable household if both of these conditions are true:
- The policy covered at least one individual in the taxpayer's applicable household and at least one individual in another applicable household, and
- The taxpayer received Form 3895 that doesn't accurately represent the members of their applicable household who were enrolled in the policy, i.e., it either lists someone who is not in their applicable household or does not list a member of their applicable household who was enrolled in the policy, or
- The other applicable household received Form 3895 for the policy that includes a member of the taxpayer's applicable household.
Complete the "Allocation of Policy Amounts". You will need the Policy Number, SSN of the taxpayer you are sharing the policy with, allocation start month, allocation end month, and the percentages for Premium, SLCSP and PTC Advance Payment.
Alternative Calculation for Year of Marriage (Part 5)
Using the "Alternative Calculation for Year of Marriage" can potentially lower the amount of APAS to repay in the year the taxpayer and spouse were married. You can check this check box to utilize this calculation if all of the following statements are true:
- The taxpayer and spouse were unmarried on January 1.
- The taxpayer and spouse were married on December 31.
- The taxpayer and spouse are filing a joint return.
- One or more individuals in the applicable household was enrolled in a qualified health plan before they married.
- APAS was paid for someone in the applicable household during the year.
You will need the following information for each spouse:
- Alternative Family Size
- Monthly contribution amount
- Alternative start month
- Alternative stop month